Twenty-one patients with common carotid artery occlusion confirmed by both angiography and duplex scanning were followed prospectively for 50 months (mean) by repeated clinical and duplex examination. Intracranial vessels were investigated in 16 patients using transcranial Doppler sonography and compared with an age-matched group of controls with normal angiographic findings. A patent bifurcation was found in 12 common carotid artery occlusions, in 10 of these flow was maintained from the external to the internal carotid artery, and in 2 the flow direction was opposite. In 10 instances both internal and common carotid arteries were occluded. Maximal and mean velocities in the middle cerebral artery were 64 ± 22 and 43 ± 16 cm/s on the occluded side, 85 ± 44 and 52 ± 23 cm/s on the non-occluded side, and 84 ± 12 and 56 ± 9 cm/s in controls (p < 0.05). Pulse curves in the middle cerebral artery had different shapes with significantly delayed pulse rise time (p < 0.01) and acceleration (p < 0.001, compared to the normal controls). Cross-over collaterals via the anterior cerebral artery were found only in association with stenosis < 75% on the contralateral side, whereas posterior collaterals were commoner if contralateral stenosis > 75% was present. Most patients with common carotid artery occlusion and patent bifurcation experienced attacks of amaurosis fugax and vertigo, but none with patent bifurcation and well-functioning intracranial collaterals had a major stroke. In contrast, 5 of 10 patients with combined internal and common carotid artery occlusion had a major stroke.

Keywords:
Common carotid artery occlusion, Duplex scanning, Transcranial Doppler sonography
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© 1991 S. Karger AG, Basel
1991
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